a·nach·ro·nism (
-n
k
r-n
z
m)
noun
1. The representation of someone as existing or something as happening in other than chronological, proper, or historical order.
2. One that is out of its proper or chronological order, especially a person or practice that belongs to an earlier time.
from Latin anachronismus, from Greek anakhronismos a mistake in chronology, from anakhronizein to err in a time reference, from ana- + khronos time]
Perhaps I live in a rarified atmosphere out of touch with the pulse of things, but this strikes me as a relic of days hopefully behind us – something in the range of a double-knit leisure suit with bell-bottoms, or perhaps the Ghost of Christmas Past in a Dickens holiday TV special:
Remission in MDD
CME Outfitters, along with faculty experts Charles B. Nemeroff, MD, PhD, Roger S. McIntyre, MD, FRCPC, and Michael E. Thase, MD welcome registration for the upcoming neuroscienceCME Live and On Demand Program: Remission in MDD: What Does the Future Hold for Clinicians and Patients?
December 04, 2014
CME Outfitters [CMEO], a leading accredited provider in continuing medical education, announces its upcoming neuroscienceCME Live and On Demand activity, Remission in MDD: What Does the Future Hold for Clinicians and Patients? The live program will launch on Wednesday, January 7, 2015 at 12:00pm ET. Faculty experts Charles B. Nemeroff, MD, PhD, Roger S. McIntyre, MD, FRCPC, and Michael E. Thase, MD will lead an interactive one-hour discussion that will challenge clinicians to reinvent the future of major depressive disorder treatment which includes increased patient participation in the treatment process, measurement-based care and a re-definition of treatment to remission as improvement of all symptoms of MDD with functional recovery. Psychiatrists, primary care physicians, nurse practitioners, physician assistants, nurses, pharmacists, social workers, clinical case managers, and other health care professionals who share the goal of achieving remission in patients with MDD are encouraged to register.
“We have a faculty panel that exhibit some of the brightest minds in mental health care today,” said Jan Perez, CCMEP, CME Outfitters Managing Partner, “It has been a pleasure working with these experts, and I think the viewers are going walk away from this program with many new clinical tactics that they can immediately implement into practice to improve the lives of their patients with MDD.”
At the end of this activity, participants should be able to:
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Evaluate all patients with major depressive disorder [MDD] for residual symptoms with a validated tool at each visit.
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Initiate a treatment plan that involves patient participation to address residual symptoms of depression.
Well, this really is a blast from the past even if it does say reinvent the future in the blurb. It’s given by three KOLs from the heyday of what we might call the Antidepressant Era – a time when we’d forgotten the distinction between Major Depression like that seen in Manic-Depressive Illness and Melancholia and the much more common depressions once called Neurotic Depression. We’d forgotten that depression, even the true Majors, was known to be time limited. We’d forgotten that people get depressed because of their life circumstances and were seeing depression more like an affliction of the physical kind, an entity. It was a time when the notion of treating to remission was all the rave and coming to us from TMAP, the STAR*D study, CO-MED, that series of programs and studies arising from Drs. Rush and Trivedi at UT Southwestern. It was a time when depression not responding to medicine gained a moniker of its own – Treatment Resistant Depression [TRD] and was being attacked with schemes like sequencing, combining, or augmenting to enhance antidepressant effectiveness. It was also a period when these presenters were at the top of their game, with Dr. Nemeroff holding forth at Emory. Our journals were filled with review articles and novel treatments. But those were the days before Senator Grassley had revealed the unreported pharmaceutical income flowing into pockets where it didn’t belong [and Dr. Nemeroff abruptly changed universities]. So it’s hard to believe that there’s anyone who hasn’t heard all of what’s advertised here. It’s been around for such a long time. But that’s not why I posted it. There’s a new wrinkle in the fabric:
Back in what I’m calling
the Antidepressant Era, there was a push for automation, short-cuts in following patients. They talked about depression like it was a condition like anemia and that one could follow it with something like the serum hemoglobin. Lacking such a marker, there were any number of tries at inventing a simple surrogate. Dr. Spitzer and colleagues developed a brief scale for measuring depression, the PHQ-9 [Patient Health Questionnaire] based on the then new DSM criteria that was distributed by Pfizer. When the STAR*D came along, there were other of self-rated Depression scales, the IDS [Inventory of Depressive Symptomatology] and the QIDS [Quick Inventory of Depressive Symptomatology]. The QIDS was developed as an automated telephone option. And in the STAR*D reporting, these instruments [clinician administered, self administered, and telephone administered] were mixed in ways I never could quite figure out. Also, that was a time of algorithms for choosing the antidepressants, including computer programs to pick and change the drugs – though the actual NIMH funded study of computer directed treatment never got off the ground – the clinicians wouldn’t use it [
IMPACT]. All of this was called Measurement Based Care. It was as if this entity called MDD could be diagnosed and treated automatically with almost no human contact [see
a thirty-five million dollar misunderstanding…].
Recently, there’s a new kid on the block – CAT-D. A couple of years ago, Dr. Robert Gibbons, a statistician teamed up with Dr. David Kupfer [in charge of the DSM-5 Revision] and others to introduce a new test – a computerized scale using artificial intelligence technology to produce a depression index by answering only a few questions on the computer, or a smart phone. It was later revealed that this was a future commercial product, already incorporated, that was in line with the notion of a new "Dimensional" axis for diagnosis planned for the DSM-5 – raising questions about the involvement of the company’s principals, all of whom had a place in the DSM-5 Task Force developing such a commercial product without declaring the COI [see open letter to the APA…]. Since apologizing for not noting that this is a commercial product in their journal articles [Failure to Report Financial Disclosure Information], these authors/entrepreneurs haven’t said much about their instrument, obviously targeted towards screening for depression or following treatment.
So when I read about this retro and anachronistic CME from Dr. Nemeroff et al, I understandably wondered if the "
validated tool" mentioned was the
CAT-D. about to make its debut on the world stage as a way to "
Evaluate all patients with major depressive disorder [MDD] for residual symptoms" – its time come round at last. It occurred to me because the "
validated tool" is so cryptic, and Dr. Gibbons has been at Dr. Nemeroff’s University of Miami Grand Rounds in the last year or so [
and they run in the same circles?]. Just a bit of a paranoid fantasy I’m having. Oh yeah, don’t miss the anachronistic
COI statements…
This frivolous confection layers trope upon anodyne upon grandiose promise. It will collapse of its own emptiness with no need for us to intervene. Whatever were they thinking at CME Outfitters? Anachronistic indeed! It takes us all the way back to a discredited earlier gig of the impresario Nemeroff.
There w as a Princess walking down a rocky path in winter when she heard a faint cry for help.
Looking she found a snake near death from the cold.
He pleaded for her to save him by warming him against her body.
She replied she knew he would bite her and she would die.
He said; Oh no, he would be in her debt.
Placing the snake in her bodice the snake soon warmed and even began to purr.
As she approached the palace gate she felt a sharp pain and soon lay dying.
She asked the snake; How could you?
He replied; You knew what I was when you picked me up.
Steve Lucas
@ Steve Lucas
Interesting – A very similar story is in a book I have of Native American Myths. It is an Apache tale of a very kindhearted boy who is convinced to do the same thing by a rattlesnake. The last line is very similar “Before you picked me up you knew I was a rattlesnake.”